Department of Neuroradiology, University Hospital Heidelberg, Heidelberg, Baden-Württemberg, Germany
Department of Neuroradiology, University Hospital Heidelberg, Heidelberg, Baden-Württemberg, Germany.
J Neurointerv Surg. 2021 Dec;13(12):1124-1127. doi: 10.1136/neurintsurg-2020-016997. Epub 2021 Jan 21.
Despite complete endovascular recanalization, a significant percentage of patients with acute anterior stroke do not achieve a good clinical outcome. We analyzed optimal thresholds of relevant parameters to discern functional independence after successful endovascular recanalization and test their predictive performance.
Patients with acute anterior ischemic stroke undergoing endovascular treatment between April 2015 and November 2019 were retrospectively analyzed. Only patients with premorbid modified Rankin Scale (mRS) score <3 and complete recanalization (modified Thrombolysis In Cerebral Infarction 2c/3) were included. Optimal thresholds of the most important variables predicting functional independence (mRS 0-2 after 90 days) were calculated using receiver operating characteristic curves and their predictive performance was tested in an independent dataset using machine learning algorithms.
Overall, 371 patients met the inclusion criteria. Optimal thresholds for the overall most important variables to predict functional independence were (1) National Institutes of Health Stroke Scale (NIHSS) score ≤5 after 24 hours (area under the curve (AUC) 0.88 (95% CI 0.84 to 0.92)); (2) Alberta Stroke Program Early CT Score (ASPECTS) ≥7 on follow-up CT (AUC 0.72 (95% CI 0.68 to 0.77)); and (3) change in NIHSS score ≥8 after 24 hours (AUC 0.70 (95% CI 0.65 to 0.74)). The performance of these thresholds to predict a good outcome using machine learning in the independent dataset was evaluated for (1) NIHSS score ≤5 after 24 hours (AUC 0.76 (95% CI 0.71 to 0.81)); (2) follow-up ASPECTS ≥7 (AUC 0.64 (95% CI 0.58 to 0.70)); (3) change in NIHSS score ≥8 after 24 hours (AUC 0.61 (95% CI 0.55 to 0.67)); and (4) the combination of all three parameters (AUC 0.84 (95% CI 0.80 to 0.88)).
After complete recanalization in acute anterior circulation ischemic stroke, a good long-term outcome could be accurately predicted reaching NIHSS score ≤5 after 24 hours.
尽管完全实现了血管内再通，但仍有相当一部分急性前循环卒中患者无法获得良好的临床结局。我们分析了相关参数的最佳阈值，以区分成功血管内再通后的功能独立性，并检验了它们的预测性能。
回顾性分析了 2015 年 4 月至 2019 年 11 月期间接受血管内治疗的急性前循环缺血性卒中患者。仅纳入了预发病变改良 Rankin 量表（mRS）评分<3 和完全再通（改良脑梗死溶栓 2c/3）的患者。使用受试者工作特征曲线计算预测功能独立性（90 天后 mRS 0-2）的最重要变量的最佳阈值，并使用机器学习算法在独立数据集上测试其预测性能。
总体而言，371 名患者符合纳入标准。预测功能独立性的最重要变量的最佳阈值为：（1）24 小时后 NIHSS 评分≤5（曲线下面积（AUC）0.88（95%CI 0.84 至 0.92））；（2）随访 CT 上 ASPECTS≥7（AUC 0.72（95%CI 0.68 至 0.77））；和（3）24 小时后 NIHSS 评分变化≥8（AUC 0.70（95%CI 0.65 至 0.74））。使用机器学习在独立数据集上评估了这些阈值对（1）24 小时后 NIHSS 评分≤5（AUC 0.76（95%CI 0.71 至 0.81））；（2）随访 ASPECTS≥7（AUC 0.64（95%CI 0.58 至 0.70））；（3）24 小时后 NIHSS 评分变化≥8（AUC 0.61（95%CI 0.55 至 0.67））；以及（4）所有三个参数的组合（AUC 0.84（95%CI 0.80 至 0.88））的良好结局的预测性能。
急性前循环缺血性卒中完全再通后，准确预测 24 小时后 NIHSS 评分≤5 可获得良好的长期结局。
